The Trump administration has maintained that CMS has the authority to impose payment cuts as a way to reduce unnecessary and costly increases in hospital procedures.
Hospital plaintiffs said Friday they will ask a federal appeals court in to reconsider its ruling last week that reversed a lower court ruling and upheld the Trump administration's legal authority to impose site-neutral payments under the Outpatient Prospective Payment System final rule.
OPPS had reduced reimbursement rates for clinic visits at hospital-owned outpatient provider departments by 40%, to match the rates paid for clinic visits in physician offices. The Centers for Medicare & Medicaid Services estimates that the OPPS final rule could save the Medicare program about $760 million in 2020.
In AHA v. Azar, the U.S. Court of Appeals for the District of Columbia Circuit ruled unanimously in favor of the Department of Health and Human Services, reversing district judge's ruling last September that CMS acted in a way that was "manifestly inconsistent with the statutory scheme" when it finalized the site-neutral payment as part of the OPPS final rule for 2019.
The Trump administration has maintained that CMS has the authority to impose payment cuts as a way to reduce unnecessary and costly increases in hospital procedures.
The American Hospital Association, the Association of American Medical Colleges, Olympic Medical Center in Port Angeles, Washington, Mercy Health in Muskegon, Michigan, and York Hospital in York, Maine, said that the appeals court did not strictly construe the statutory authority that binds the agency, "unaccountably deferring to impermissible agency decisions."
"These illegal cuts directly undercut the clear intent of Congress to protect hospital outpatient departments because of the many real and crucial differences between them and other sites of care," the plaintiffs said in a joint statement.
"These hospital outpatient departments are held to higher regulatory standards and are often the only point of access for patients with the most severe chronic conditions, all of whom receive treatment regardless of ability to pay. We look forward to a prompt rehearing of our case to overturn these unlawful cuts," the plaintiffs said.
“These illegal cuts directly undercut the clear intent of Congress to protect hospital outpatient departments because of the many real and crucial differences between them and other sites of care.”
AHA, et al.
John Commins is a content specialist and online news editor for HealthLeaders, a Simplify Compliance brand.
KEY TAKEAWAYS
In AHA v. Azar, a appeals court ruled unanimously in favor of HHS, reversing district judge's ruling last September.
The Trump administration has maintained that CMS has the authority to impose payment cuts as a way to reduce unnecessary and costly increases in hospital procedures.
The plaintiff hospitals say the appeals court did not strictly construe the statutory authority that binds the agency, "unaccountably deferring to impermissible agency decisions."